Assessing Existing Food Safety Resources with United Kingdom-Based Chemotherapy Patients and Family Caregivers for Future Learning Purposes.

ABSTRACT: Because the incidence of foodborne infection is more prevalent among cancer patients and the domestic kitchen is a contributor to foodborne infection, appropriate domestic food safety practices are needed to safeguard this at-risk population. Although patients are aware of the increased risk of infection, previous self-reported data indicate potential food safety malpractices among patients and family caregivers, thus suggesting the need for targeted food safety information. However, existing United Kingdom resources provide inconsistent and insufficient food safety information. Involvement of intended end users in the cocreation of interventions increases potential effectiveness. Qualitative data were collated from in-depth interviews and a focus group with United Kingdom chemotherapy patients and family caregivers (n = 35) to determine perceptions and preferences for food safety information by evaluating existing food safety resources from international providers (n = 12). Although participants liked digital interventions (e.g., Web sites and videos), traditional paper-based leaflets were perceived as the most beneficial because they could be referred to on repeated occasions. Despite the drawbacks associated with some resources, combining approaches in a multiresource intervention was favored by patients and family caregivers. Ensuring patients are not overwhelmed with excessive information was important. Short, logical, engaging, educational, and entertaining information to evoke an interest in the topic was preferred. Utilization of graphics to supplement descriptive information may enhance comprehensibility. Interventions need to be appropriate for patients and caregivers, and delivery by trusted health care professionals may enhance the credibility of the message. Preferred approaches to facilitate targeted food safety communication were identified, and these findings can be utilized to cocreate targeted food safety interventions for chemotherapy patients and family caregivers.

Enzalutamide and Apalutamide: In Vitro Chemical Reactivity Studies and Activity in a Mouse Drug Allergy Model.

Enzalutamide and apalutamide are two androgen receptor inhibitors approved for the treatment of castration-resistant prostate cancer (CRPC) and nonmetastatic castration-resistant prostate cancer (nmCRPC), respectively. Apalutamide is associated with an increased incidence of skin rash above the placebo groups in the SPARTAN trial in nmCRPC and in the TITAN trial in metastatic castration-sensitive prostate cancer patients. On the contrary, the rate of skin rash across all clinical trials (including PROSPER [nmCRPC]) for enzalutamide is similar to the placebo. We hypothesized that the apalutamide-associated increased skin rash in patients could be linked to a structural difference. The 2-cyanophenyl and dimethyl moieties in enzalutamide are substituted in apalutamide with 2-cyanopyridine and cyclobutyl, respectively. In our evaluations, the 2-cyanopyridine moiety of apalutamide was chemically reactive with the thiol nucleophile glutathione, resulting in rearranged thiazoline products. Radiolabeled apalutamide, but not radiolabeled enzalutamide, was shown to react with mouse and human plasma proteins. Thiol nucleophiles decreased the extent of covalent binding to the model protein bovine serum albumin, whereas amine and alcohol nucleophiles had no effect, suggesting reactivity with cysteine of proteins. Subcutaneous administration of apalutamide dose dependently increased lymphocyte cellularity in draining lymph nodes in a mouse drug allergy model (MDAM). Enzalutamide, and its known analogue RD162 in which the cyanophenyl was retained but the dimethyl was replaced by cyclobutyl, demonstrated substantially less covalent binding activity and negative results in the MDAM assay. Collectively, these data support the hypothesis that the 2-cyanopyridine moiety in apalutamide may react with cysteine in proteins forming haptens, which may trigger an immune response, as indicated by the activity of apalutamide in the MDAM assay, which in turn may be leading to increased potential for skin rash versus placebo in patients in the SPARTAN and TITAN clinical trials.

Mortality Risk Reductions for Replacing Sedentary Time With Physical Activities.

INTRODUCTION: Excess sitting is a risk factor for early mortality. This may be resulting, at least in part, from the displacement of physical activity with sedentary behaviors. The purpose of this observational study was to examine the mortality risk reductions associated with replacing 30minutes/day sitting for an equivalent duration of light or moderate to vigorous physical activity (MVPA). METHODS: Participants included 37,924 men and 54,617 women in the Cancer Prevention Study-II Nutrition Cohort, of which 14,415 men and 13,358 women died during follow-up (1999-2014). An isotemporal substitution approach to the Cox proportional hazards regression model was used to estimate adjusted hazard ratios and 95% CIs for mortality associated with the substitution of 30minutes/day self-reported sitting for light physical activity or MVPA. Analyses were conducted in 2018. RESULTS: Among the least active participants (≤17minutes/day MVPA), the replacement of 30minutes/day sitting with light physical activity was associated with a 14% mortality risk reduction (hazard ratio=0.86, 95% CI=0.81, 0.89) and replacement with MVPA was associated with a 45% mortality risk reduction (hazard ratio=0.55, 95% CI=0.47, 0.62). Similar associations were seen among moderately active participants (light physical activity replacement, hazard ratio=0.94, 95% CI=0.91, 0.97; MVPA replacement, hazard ratio=0.83, 95% CI=0.76, 0.88). However, for the most active (MVPA >38 minutes/day), substitution of sitting time with light physical activity or MVPA was not associated with a reduction in mortality risk (hazard ratio=1.00, 95% CI=0.97, 1.03, and hazard ratio=0.99, 95% CI=0.95, 1.02, respectively). CONCLUSIONS: These findings suggest that the replacement of modest amounts of sitting time with even light physical activity may have the potential to reduce the risk of premature death among less active adults.

Demographic-specific Validity of the Cancer Prevention Study-3 Sedentary Time Survey.

PURPOSE: This study examined the 1-yr test-retest reliability and criterion validity of sedentary time survey items in a subset of participants from a large, nationwide prospective cohort. METHODS: Participants included 423 women and 290 men age 31 to 72 yr in the Cancer Prevention Study-3. Reliability was assessed by computing Spearman correlation coefficients between responses from prestudy and poststudy surveys. Validity was assessed by comparing survey-estimated sedentary time with a latent variable representing true sedentary time estimated from the 7-d diaries, accelerometry, and surveys through the method of triads. Sensitivity analyses were restricted to 566 participants with an average of 14+ h of diary and accelerometer data per day for 7 d per quarter. RESULTS: Reliability estimates for total sitting time were moderate or strong across all demographic strata (Spearman ρ ≥ 0.6), with significant differences by race (P = 0.01). Reliability estimates were strongest for the TV-related sedentary time item (Spearman ρ, 0.74; 95% confidence interval, 0.70-0.77). The overall validity coefficient (VC) for survey-assessed total sedentary time was 0.62 (95% confidence interval, 0.55-0.69), although VC varied by age group and activity level (P < 0.05). However, VC were similar across groups (P < 0.05) when restricting to highly compliant participants in a sensitivity analysis. CONCLUSIONS: The Cancer Prevention Study-3 sedentary behavior questionnaire has acceptable reliability and validity for ranking or categorizing participants according to sedentary time. Acceptable reliability and validity estimates persist across various demographic subgroups.

Food Safety Knowledge and Self-Reported Food-Handling Practices in Cancer Treatment.

OBJECTIVES: To explore awareness of foodborne infection risk during chemotherapy treatment, to assess knowledge of risk-reducing food safety practices in patients with cancer and their family caregivers, and to determine self-reported food-handling practices. SAMPLE & SETTING: A convenience sample of 121 patients receiving chemotherapy and 51 family caregivers of patients receiving chemotherapy in the United Kingdom recruited in the community and using online advertising. METHODS & VARIABLES: Participants completed a self-report questionnaire to determine food safety knowledge and self-reported food-handling practices. RESULTS: Although patients receiving chemotherapy and family caregivers reported awareness of food safety practices, self-reported practices indicated that potentially unsafe practices may be used in relation to temperature control, handwashing, safe cooking, and adherence to use-by dates. Such practices may increase the risk of foodborne illness to patients receiving chemotherapy treatment. IMPLICATIONS FOR NURSING: Nursing research is required to explore the food safety training and awareness of healthcare providers. Highly focused and specifically targeted food safety interventions need to be developed and delivered to increase awareness and to implement food safety practices.

Markers of Inflammation.

Inflammation is a complex and necessary component of the response to biological, chemical, or physical stimuli, and the cellular and molecular events that initiate and regulate the interactions between the various players in the inflammatory process remain a source of ongoing investigation. In the acute phase of the inflammatory response, cells of the immune system migrate to the site of injury in a carefully orchestrated sequence of events that is facilitated by soluble mediators such as cytokines, chemokines, and acute-phase proteins. Depending on the degree of injury, this acute phase may be sufficient to resolve the damage and initiate healing processes. Persistent inflammation, either as a result of prolonged exposure to stimulation or an inappropriate reaction against self-molecules, can lead to the chronic phase, in which tissue damage and fibrosis can occur. Chronic inflammation has been reported to contribute to numerous diseases, including arthritis, asthma, atherosclerosis, autoimmune diseases, diabetes, and cancer, and to conditions of aging. Hematology and clinical chemistry data from standard toxicology studies can provide an initial indication of the presence and sometimes the location of inflammation. These data may suggest more specific immune function assays that are necessary to determine the presence and/or mechanism(s) of immunomodulation. Although changes in hematology dynamics, acute-phase proteins, complement factors, and cytokines are common to virtually all inflammatory conditions, and can be measured by a variety of techniques, individual biomarkers have yet to be strongly associated with specific pathologic events. Thus, although sensitive indicators of inflammation, these factors generally lack the specificity to identify the offending cause. The profile seen in a given inflammatory condition is dependent on the severity, chronicity, and mechanisms involved in the inflammatory process, as well as the species and the capacity of the individual's immune system to respond and adapt.

Implementation of an Early Warning Scoring System to Identify Patients With Cancer at Risk for Deterioration.

Early warning scoring systems are tools for nurses to help monitor their patients and improve how quickly a patient experiencing a sudden decline receives clinical care. Nurse leaders and frontline staff at a major academic medical center implemented a new early warning system that gives clear guidelines to nurses, nursing assistants, and other clinicians about vital-sign parameters and changes in patients' mental status. 
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Comparison of Intake of Animal and Plant Foods and Related Nutrients in Postmenopausal Breast Cancer Survivors and Controls.

This study's objective is to assess differences in dietary intakes in breast cancer survivors (n = 13) and women without a history of breast cancer (controls, n = 71). In a cross-sectional design, intake of foods, food groups, nutrients, and non-nutritive sweeteners was assessed using participant-completed three-day food records. All women were postmenopausal (mean age (SD) 58.5 (±3.8) y, 95% White, 2.4% Asian Pacific, and 2.4% Black). The two groups did not differ in age, energy intake, or body mass index (p > 0.05). Compared to controls, survivors consumed less dairy products, animal protein, total protein, and calcium, but more legumes, noncitrus fruit, and carbohydrates (p ≤ 0.05). Calcium intakes were of particular concern in survivors who consumed an average of 686 mg calcium/d, which is <60% of the recommended 1200 mg/d. Given the important role of calcium in bone health and protein in muscle function among aging women, breast cancer survivors may benefit from consultation with a Registered Dietitian or other health professional knowledgeable in nutritional recommendations for postmenopausal breast cancer survivors.

Psychometric evaluation of dietary self-efficacy and outcome expectation scales in female college freshmen.

Lifestyle interventions commonly measure psychosocial beliefs as precursors to positive behavior change, but often overlook questionnaire validation. This can affect measurement accuracy if the survey has been developed for a different population, as differing behavioral influences may affect instrument validity. The present study aimed to explore psychometric properties of self-efficacy and outcome expectation scales-originally developed for younger children-in a population of female college freshmen (N = 268). Exploratory principal component analysis was used to investigate underlying data patterns and assess validity of previously published subscales. Composite scores for reliable subscales (Cronbach's α ≥ .70) were calculated to help characterize self-efficacy and outcome expectation beliefs in this population. The outcome expectation factor structure clearly comprised of positive (α = .81-.90) and negative outcomes (α = .63-.67). The self-efficacy factor structure included themes of motivation and effort (α = .75-.94), but items pertaining to hunger and availability cross-loaded often. Based on cross-loading patterns and low Cronbach's alpha values, respectively, self-efficacy items regarding barriers to healthy eating and negative outcome expectation items should be refined to improve reliability. Composite scores suggested that eating healthfully was associated with positive outcomes, but self-efficacy to do so was lower. Thus, dietary interventions for college students may be more successful by including skill-building activities to enhance self-efficacy and increase the likelihood of behavior change.

Understanding weight management perceptions in first-year college students using the health belief model.

OBJECTIVE: To examine weight management barriers, using the Health Belief Model, in first-year college students. PARTICIPANTS: First-year college students (n = 45), with data collected in April, May, and November 2013. METHODS: Nominal group technique sessions (n = 8) were conducted. RESULTS: First-year students recognize benefits to weight management beyond physical attractiveness to quality-of-life domains, including social (eg, bonding opportunities and energy to socially engage) and mental health (eg, stress management). Men believe that weight management is important for career/financial reasons, whereas women voiced that it will allow them to live a full, independent life with a high level of multitasking. Men believed that their barriers were external (eg, campus resources/programs), whereas females perceived their barriers to be internal (eg, poor time management). CONCLUSIONS: College students are challenged by weight management and want the institution to provide resources, including curriculum, to help them manage their physical activity and nutrition behaviors.

Effect of six weeks of sprint interval training on mood and perceived health in women at risk for metabolic syndrome.

The purpose of this investigation was to determine whether 6 weeks of sprint interval training (SIT) is associated with changes in mood and perceived health in women at risk for developing metabolic syndrome (MetS). Physically inactive women (30-65 years) were randomized to 6 weeks of nutrition meetings and SIT (n = 23; 3 bouts/week of 4-8 30-s cycle sprints with 4-min recovery) or a nonexercise control condition (CON; n = 24). Before and after the 6-week intervention, perceived health status and mood were assessed. Clinically relevant increases in role-physical scores (ES = 0.64) and vitality (ES = 0.52) were found after 6 weeks of SIT compared with a nonexercise control group. For middle-aged women at risk for MetS, it is concluded that high-intensity, low-volume SIT (1) increases feelings of vitality and perceptions of having fewer physical limitations and (2) does not induce mood disturbances as occurs with high-volume, high-intensity training.

The associations of adiposity, physical activity and inflammation with fatigue in older adults.

Persistent feelings of fatigue are a widespread complaint reported by older adults, and are associated with detriments in health and quality of life. The aim of this study was to determine the influence of weight status, habitual physical activity and inflammation, after controlling for common psychosocial variables such as depression, on perceptions of fatigue in relatively healthy older adults. Older men and women (N=182, age=69.2±6.7 years, 98 men) were assessed for adiposity via dual-energy X-ray absorptiometry, physical activity (PA) using accelerometers, systemic inflammation [serum C-reactive protein (CRP), interleukin-6 (IL-6), sIL-6R and WBC count], fatigue according to the Multidimensional Fatigue Inventory (MFI), sleep using the Pittsburgh Sleep Quality Index (PSQI) and depression via the Geriatric Depression Scale (GDS). Men and women reported similar levels of fatigue in all dimensions (p>0.05) except women reported higher levels of mental fatigue than men (p=0.049). With the exception of mental fatigue, adiposity was positively, and physical activity was inversely associated with all other dimension of fatigue (r range=0.20-0.42, and -0.18 to -0.37, respectively). CRP, IL-6 and WBC were also related to several dimensions of fatigue (r range=0.15-0.26). Regression analyses revealed that after controlling for other factors, including depression and sleep quality, adiposity independently explained a significant amount of the variance in general and physical fatigue. In addition to depression and sleep quality, adiposity may represent a potential target for reducing fatigue in older adults.

Adiposity and aerobic fitness are associated with metabolic disease risk in children.

To examine the relative association of physical activity, cardiorespiratroy fitness (CRF), and adiposity with risk for metabolic disease in prepubescent children. Forty-six prepubescent children (age, 9.4 ± 1.7 years; 24 males) were assessed for adiposity (%fat) via dual-energy X-ray absorptiometry, CRF with a peak graded exercise test, and physical activity using pedometers. Metabolic disease risk was assessed by a composite score of the following factors: waist circumference (WC), mean arterial pressure (MAP), triacylglycerol (TAG), total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C ratio), glucose, and insulin. Adiposity was correlated with metabolic disease risk score, as well as homeostasis model assessment of insulin resistance (HOMA-IR), TAG, TC/HDL-C ratio, WC, insulin, and MAP (r range = 0.33 to 0.95, all p < 0.05). Physical activity was negatively associated with metabolic disease risk score, as well as HOMA-IR, TAG, WC, insulin, and MAP (r range = -0.32 to -0.49, all p < 0.05). CRF was inversely associated with metabolic disease risk score and HOMA-IR, TAG, TC/HDL-C ratio, WC, insulin, and MAP (r range = -0.32 to -0.63, all p < 0.05). Compared across fitness-physical activity and fatness groups, the low-fit-high-fat and the low-activity-high-fat groups had higher metabolic risk scores than both low-fat groups. Regression analyses revealed sexual maturity (ß = 0.27, p = 0.044) and %fat (ß = 0.49, p = 0.005) were the only independent predictors of metabolic disease risk score, explaining 4.7% and 9.5% of the variance, respectively. Adiposity appears to be an influential factor for metabolic disease risk in prepubescent children, and fitness is protective against metabolic disease risk in the presence of high levels of adiposity.

Breast tumors induced by N-methyl-N-nitrosourea are damaging to bone strength, structure, and mineralization in the absence of metastasis in rats.

Current theory on the influence of breast cancer on bone describes metastasis of tumor cells to bone tissue, followed by induction of osteoclasts and bone degradation. Tumor influences on bone health in pre- or nonmetastatic models are unknown. Female rats (n = 48, 52 days old) were injected with N-methyl-N-nitrosourea (MNU) to induce breast cancer. Animals were euthanized 10 weeks later, and tumors were weighed and classified histologically. Right femurs were extracted for testing of bone mineral density (BMD) by dual X-ray absorptiometry (DXA), bone mechanical strength by three-point bending and femoral neck bending tests, and structure by micro-computed tomography (µCT). Of 48 rats, 22 developed one or more tumors in response to MNU injection by 10 weeks. Presence of any tumor predicted significantly poorer bone health in 17 of 28 measures. In tumored versus nontumored animals, BMD was adversely affected by 3%, force at failure of the femoral midshaft by 4%, force at failure of the femoral neck by 12%, and various trabecular structural parameters by 6% to 27% (all p < .05). Similarly, greater tumor burden, represented by total tumor weight, adversely correlated with bone outcomes: r = -0.51 for BMD, -0.42 and -0.35 for femur midshaft force and work at failure, and between 0.36 and 0.59 (absolute values) for trabecular architecture (all p < .05). Presence of MNU-induced tumors and total tumor burden showed a negative association with bone health of the femur in rats in the absence of metastasis. Further study is required to elucidate mechanisms for this association.

Travel distance as factor in follow-up visit compliance in postlaparoscopic adjustable gastric banding population.

BACKGROUND: Despite the 2008 "American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient," consensus does not exist for postoperative care in laparoscopic adjustable gastric banding (LAGB) patients (grade D evidence). It has been suggested that regular follow-up is related to better outcomes, specifically greater weight loss. The aim of the present study was to investigate the effects of travel distance to the clinic on the adherence to follow-up visits and weight loss in a cohort of LAGB patients in the setting of a rural, university-affiliated teaching hospital in the United States. METHODS: A retrospective chart review was performed of all consecutive LAGB patients for a 1-year period. Linear regression analysis was used to identify the relationships between appointment compliance and the distance traveled and between the amount of weight loss and the distance traveled. RESULTS: Linear regression analysis was performed to investigate the effect of the travel distance to the clinic on the percentage of follow-up visits postoperatively. This effect was not significant (P = .4). Linear regression analysis was also performed to elucidate the effect of the travel distance to the clinic on the amount of weight loss. This effect was significant (P = .04). CONCLUSION: The travel distance to the clinic did not seem to be a significant predictor of compliance in a cohort of LAGB patients with ≤ 1 year of follow-up in a rural setting. However, a weak relationship was found between the travel distance to the clinic and weight loss, with patients who traveled further seeming to lose slightly more weight.

Markers of inflammation.

Inflammation is a complex and necessary component of an organism's response to biological, chemical or physical stimuli. In the acute phase, cells of the immune system migrate to the site of injury in a carefully orchestrated sequence of events that is mediated by cytokines and acute phase proteins. Depending upon the degree of injury, this acute phase may be sufficient to resolve the damage and initiate healing. Persistent inflammation as a result of prolonged exposure to stimulus or an inappropriate reaction to self molecules can lead to the chronic phase, in which tissue damage and fibrosis can occur. Chronic inflammation is reported to contribute to numerous diseases including allergy, arthritis, asthma, atherosclerosis, autoimmune diseases, diabetes, and cancer, and to conditions of aging. Hematology and clinical chemistry data from standard toxicology studies can provide an initial indication of the presence and sometimes location of inflammation in the absence of specific data on the immune tissues. These data may suggest more specific immune function assays are necessary to determine the existence or mechanism(s) of -immunomodulation. Although changes in hematology dynamics, acute phase proteins, complement factors and cytokines are common to virtually all inflammatory conditions and can be measured by a variety of techniques, individual biomarkers have yet to be strongly associated with specific pathologic events. The specific profile in a given inflammatory condition is dependent upon species, mechanisms, severity, chronicity, and capacity of the immune system to respond and adapt.

Summary of a workshop on nonclinical and clinical immunotoxicity assessment of immunomodulatory drugs.

The number of anti-inflammatory and immunomodulatory drugs being developed in the pharmaceutical industry has increased considerably in the past decade. This increase in research and development has been paralleled by questions from both regulatory agencies and industry on how best to assess decreased host resistance to infections or adverse immunostimulation caused by immunomodulatory agents such as anti-cytokine antibodies (e.g., the tumor necrosis factor-alpha inhibitors), anti-adhesion molecule antibodies (e.g., anti-alpha-4 integrin inhibitors) and immunostimulatory molecules (e.g., anti-CD28 antibodies). Although several methods have been developed for nonclinical assessment of immunotoxicity, highly publicized adverse events have brought to light significant gaps in the application of nonclinical immunotoxicity testing in assessing potential risk in humans. Confounding this problem is inconsistent application of immunotoxicology methods for risk assessment within the scientific community, limited understanding of appropriate immunotoxicity testing strategy for immunomodulators and inconsistent testing requests by regulatory agencies. To address these concerns, The Immunotoxicology Technical Committee (ITC) of the International Life Science Institute (ILSI) Health and Environmental Sciences Institute (HESI) organized a workshop on Immunomodulators and Clinical Immunotoxicology in May 2007. The Workshop was convened to identify key gaps in nonclinical and clinical immunotoxicity testing of anti-inflammatory and immunomodulatory agents and to begin to develop consistent approaches for immunotoxicity testing and risk assessment. This paper summarizes the outcome of the HESI ITC Immunomodulators and Clinical Immunotoxicology Workshop. Topics not discussed at the Workshop were outside the scope of this report. Although more work is needed to develop consistent approaches for immunotoxicity assessment of immunomodulators, this Workshop provided the foundation for future discussion.

A positive association of lumbar spine bone mineral density with dietary protein is suppressed by a negative association with protein sulfur.

Dietary protein is theorized to hold both anabolic effects on bone and demineralizing effects mediated by the diet acid load of sulfate derived from methionine and cysteine. The relative importance of these effects is unknown but relevant to osteoporosis prevention. Postmenopausal women (n = 161, 67.9 +/- 6.0 y) were assessed for areal bone mineral density (aBMD) of lumbar spine (LS) and total hip (TH) using dual X-ray absorptiometry, and dietary intakes of protein, sulfur-containing amino acids, and minerals using a USDA multiple-pass 24-h recall. The acidifying influence of the diet was estimated using the ratio of protein:potassium intake, the potential renal acid load (PRAL), and intake of sulfate equivalents from protein. aBMD was regressed onto protein intake then protein was controlled for estimated dietary acid load. A step-down procedure assessed potential confounding influences (weight, age, physical activity, and calcium and vitamin D intakes). Protein alone did not predict LS aBMD (P = 0.81); however, after accounting for a negative effect of sulfate (beta = -0.28; P < 0.01), the direct effect of protein intake was positive (beta = 0.22; P = 0.04). At the TH, protein intake predicted aBMD (beta = 0.18; P = 0.03), but R2 did not improve with adjustment for sulfate (P = 0.83). PRAL and the protein:potassium ratio were not significant predictors of aBMD. Results suggest that protein intake is positively associated with aBMD, but benefit at the LS is offset by a negative impact of the protein sulfur acid load. If validated experimentally, these findings harmonize conflicting theories on the role of dietary protein in bone health.

Independent relationship between heart rate recovery and C-reactive protein in older adults.

OBJECTIVES: To examine the independent effect of parasympathetic tone (PST), assessed here according to heart rate recovery (HRR) after exercise, on circulating levels of C-reactive protein (CRP) in 132 elderly participants. DESIGN: Cross-sectional analysis using baseline data from an ongoing trial assessing the effects of exercise on immune function. SETTING: Champaign/Urbana, Illinois, vicinity. PARTICIPANTS: Community-living older adults who had been sedentary for 6 months or longer. Major exclusion criteria were current use of medications that could interfere with immunity, severe arthritis, history of cancer or inflammatory disease, recent illness or vaccination, and smoking. MEASUREMENTS: Participants were assessed for serum CRP (using enzyme-linked immunosorbent assay), cardiorespiratory fitness (peak oxygen intake (VO(2))), HRR, percentage body fat (using dual-energy x-ray absorptiometry), physical activity level (according to the Physical Activity Scale for the Elderly (PASE)), fasting plasma glucose, kidney function (creatinine level), and perceived stress. RESULTS: Mean CRP level+/-standard deviation was 3.81+/-2.7 mg/L, placing this group in a high-risk category. After adjusting for the effects of body fat (34.6%+/-7.4%), aspirin use, VO(2) peak (19.5+/-3.9 mL oxygen/kg per minute), PASE, sex (64% women), and perceived stress, HRR was the only independent predictor of CRP (beta=-0.257, P=.003, change in coefficient of determination=0.060). CONCLUSION: HRR after exercise appears to be independently associated with lower CRP in older sedentary individuals, suggesting that the parasympathetic nervous system is involved in regulating chronic inflammation in older adults. Improvements in PST, as a result of regular physical exercise, may contribute to the antiinflammatory effects of exercise, independent of physical fitness or fatness.